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In our discussions, we will often use the term “clinical” and the phrase “clinical enterprise”. This are distinct from one another. While the clinical enterprise includes everything included in the word clinical, it also implies all of the administrative and support functions required to perform any clinical service. In order to properly address the changes that our impacting our practices we must consider the entire clinical enterprise. Clinicians’ failure in recognizing the entire clinical enterprise as part of our “clinical” is why it feels that all of us our working on the same thing, at the same time, with different outcomes and recommendations. We must engage the clinical enterprise on common problems if we hope to identify a single solution everyone might implement.
The clinical network is something we all understand however, we may not have ever given it a second thought. It is the connection, or the way we connect, with all of the other clinical services within our clinical enterprise. It concisely describes how we collaborate with one another to effectively care for our patients.
It’s an important distinction in that thinking of our services as interdependent is crucial to understanding the value in collaboration.
Confining our thinking to our own practice or group makes good business sense. It’s the strategy we’ve always relied upon when making decisions that impact our practice.
If that’s true in your case, how is your business going? Are you thriving? Are you having to take on
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April 25, 2026
Hello and welcome to the Clinical Network Collaborative. My name is David Foster and I am a Family Physician. I began my career as a primary care physician serving patients along the Texas Gulf Coast. In a relatively short time I came to realize that I spent as much time dealing with the challenges of delivering healthcare as I did caring for patients. At first, I was troubled by this. I shared my concerns with colleagues and, the only response that seemed to offer me any hope was to “control what you can control”. With that premise I determined I would leverage my frustrations into a call for action. I needed to learn what I might be able to control.
I began by volunteering my time on various governing committees in an attempt to gain more influence over my practice. Early on I was recognized for my leadership and how I contributed to collaborative efforts at problem solving. This led directly to my first formal leadership role as a director. During my time as a medical director I assumed more and more responsibility which ultimately led me into becoming the CMO for our group. I obtained an MBA in order to lend more credibility to my voice as a physician-administrative leader. This step along my path eventually led me to pursue administrative medicine on a full time basis as the president of a newly formed medical group in Arkansas. Success in that role afforded me the chance to experience leadership in a regional role over multiple medical groups and a number of clinically integrated networks. Subsequently, over the past 30+ years in healthcare, I have found that our credibility rests in the reality that we first bring value to our endeavors. As clinicians, simply caring for our patients is no longer enough. Not if we want to have a say in the forces impacting our practices.
The more value we bring to our patients and our network, the more influence and control we gain. The parties paying for healthcare (i.e. tax payers, employees and employers) are demanding that the system change. We can lead this transformation. It’s hard for me to imagine something more valuable than our ability to guide the revolution of a $5 trillion dollar marketplace.
Thus, my passion:
Engaging clinicians and our administrative colleagues to transform healthcare.
Have you heard the expression that healthcare needs to ‘do more with less’. The best example is the patient that expects the latest test, medicine or intervention even though they don’t necessarily want to pay any more for their healthcare.
I’ve experienced how health system and insurance networks try to make that expression a reality: simply add that work on to whatever clinicians are already doing. Let me assure you, there is a better way.
Health systems and insurance providers are truly doing their level best to lead this change. It’s not that they want to do this in our place, it’s that clinicians have yet to step up in a way that lends a more immediate solution. How do clinicians offer a “more immediate solution”? Like the best things in life, it’s really rather simple. It’s along the lines of the famous quote which, indirectly, goes something like: ‘What you think is what you say, what you say is what you do and what you do becomes reality.’ Mahatma Ghandi, Buddha and Lao Tzu are famous influencers each of who spoke something along those lines. Numerous other versions of that statement exist. My simple suggestion then is to share what we think and start talking to one another. Engage with your peers to build the network that best serves the needs of our patients. Speak from consensus. Divided we don’t stand a chance. If a new service or intervention is important, redesign the process of care. Don’t simply add another task to our already overfilled plates.
While physicians hold the “highest” license in healthcare, we should not attempt to do this work alone. We must engage and activate the stakeholders of our clinical networks. If we’re not careful, this is where our task is at risk of seemingly being insurmountable. These are our clinical colleagues and administrative peers who work with us to meet the needs of our patients. We cannot afford to leave out community leaders and third-party payors. When I started to make this list for my own group I admit I became more than a little dismayed. I’m proud that we didn’t give up because, as the saying goes, “…one bite at a time.” I assure you that if you don’t give up and take the time to learn what all of our stakeholders think that these concepts are truly transformative. Unfortunately they also require a level of commitment and focus few organizations possess.
I created the Clinical Network Collaborative to change that.
Healthcare doesn’t transform because of new slogans, new software, or new reporting structures. It transforms when clinicians are engaged early, supported consistently, and empowered to shape the strategy, governance, and operational decisions that define how we deliver care. That’s the core belief behind our work.
How do we ensure this happens:
We begin with these three pillars:
1. Clinician‑Led Governance
Helping organizations design governance models and administrative structures that provide clinicians with the opportunity to exert real influence—not simply symbolic seats at the table.
This includes board structures, committee design, decision rights, and leadership pathways and education for practicing clinicians.
2. Network Alignment & Integration
Supporting multi‑specialty groups, physician enterprises, and health systems as they align strategy, incentives, and operations across the network. All of us need to accept that the relationships within the network, with our patients and peers, is ultimately how we get our work done. No one is an island. Healthcare is now, more than ever, a team sport. Networks used to be informal and were largely based upon our history with a particular patient or clinician. We must become more intentional about the networks within which we serve. Clinicians bring patients into the network. The network needs to be built in a way that every outcome is optimized for the benefit of our patients. Outcomes are the ultimate currency for the value clinicians bring to healthcare. And (spoiler alert!) our patient outcomes are more dependent upon the performance of the network than our individual practices.
3. Facilitating Transformation via Collaboration
Guiding leadership teams through complex change—ensuring clinicians are engaged, informed, positioned and activated to lead the transformation, not react to it. This takes time, resolve and commitment. I have witnessed that networks built in this manner are much more supportive of our patients and practices. Engaging physicians and activating clinicians to this work requires a particular focus that most organizations lack.
If any of this resonates with you, please subscribe to receive our newsletter. Check back often to see what updates have been added. Reach out to me with your questions. In its simplest form, this collaborative is an outlet for me to share my experience and insights with those looking to shape their own practices in order to optimize the value we provide our patients and our network. The more value we bring to our patients and network, the more value they will in turn place on our practices. More value translates to more influence.
See how we got back to the beginning?
What You Can Expect from the CNC
Over the coming weeks, we’ll be sharing:
My goal is to spark dialogue — not deliver monologues. I’m looking forward to the conversation.